Policy UpdatesCommercialApril 1, 2021

Georgia Anthem preapproval list change notification 3/1/2021

AIM Speciality Health®

AIM Specialty Health, a separate company, is a nationally recognized leader delivering specialty benefits management on behalf of Anthem for certain health plan members. Determine if preapproval is needed for a Georgia Anthem member by visiting the “Medical Policy and Clinical UM Guidelines” page on our provider website or by calling the preapproval phone number printed on the back of the member’s ID card. To submit your request for any of the services below, contact AIM online via AIM’s provider portal at aimspecialtyhealth.com/goweb. From the drop-down menu, select GA. You may also call AIM toll-free at 866-714-1103, Monday–Friday, 8:00 a.m.–6:00 p.m. ET

 

AIM provides benefits management for the programs listed below:

  • Imaging level of care
  • Genetic testing
  • Diagnostic imaging management
  • Cardiovascular services
  • Radiation therapy services
  • Outpatient sleep testing and therapy services
  • Cancer care quality program
  • Musculoskeletal (for fully insured)
  • Upper gastrointestinal endoscopy


For more details on these programs, please visit the AIM Specialty Health® site at aimspecialtyhealth.com/marketing/guidelines/185/index.html. By clicking on the previous links, you will be directed to sites created and/or maintained by another, separate entity (“external site”). Upon linking you are subject to the terms of use, privacy, copyright and security policies of the external sites. We provide these links solely for your information and convenience. We encourage you to review the privacy practices of the external sites. The information contained on the external sites should not be interpreted as medical advice or treatment provided by us.

 

Eligibility and benefits

Eligibility and benefits can be verified by through anthem.com/provider or by calling the number on the back of the member’s identification card. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed/approved. Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits. Except in the case of an emergency, failure to obtain preapproval prior to rendering the designated services listed below will result in denial of reimbursement.

 

Add to preapproval

GENE.00056

Gene expression profiling for bladder cancer

0012M, 0013M, 0016M

Added 7/1/2021

LAB.00038

Cell-free DNA testing to aid in the monitoring of kidney transplants for rejection

0118U

Added 7/1/2021

SURG.00159

Focal laser ablation for the treatment of prostate cancer

0655T

Added 7/1/2021

TRANS.00037

Uterine transplantation

0664T-0670T

Added 7/1/2021

 

Codes added to existing preapproval documents

CG-GENE-14

Gene mutation testing for solid tumor cancer susceptibility and management

0229U, 81309, 0155U, 0177U; RAS 81275, 81276, 81311, 0111U; BRAF 81210

Added 4/1/2021. All moved from other MP/CGs.

GENE.00049

Circulating tumor DNA panel testing for cancer (liquid biopsy)

0242U

Added 4/1/2021

LAB.00033

Protein biomarkers for the screening, detection and management of prostate cancer

0228U

Added 5/1/2021

SURG.00121

Transcatheter heart valve procedures

0646T

Added 7/1/2021

CG-GENE-13

GenetictTesting for inherited diseases

81161, 0218U

Added 5/1/2021

GENE.00052

Whole genome sequencing, whole exome sequencing, gene panels, and molecular profiling

0244U

Added 4/1/2021

LAB.00011

Analysis of proteomic patterns

0247U

Added 4/1/2021

CG-GENE-04

Molecular marker evaluation of thyroid nodules

0245U

Added 4/1/2021

 

1088-0421-PN-GA